1265526776 NPI number — DERRICK W. DENMAN D.C. P.A.

Table of content: (NPI 1265526776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265526776 NPI number — DERRICK W. DENMAN D.C. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERRICK W. DENMAN D.C. P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265526776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLNTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-735-8226
Provider Business Mailing Address Fax Number:
704-735-8280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 NEWBOLD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLNTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-735-8226
Provider Business Practice Location Address Fax Number:
704-735-8280
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DENMAN
Authorized Official First Name:
DERRICK
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
704-735-8226

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 790186C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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